Rupture of vulnerable plaque of carotid artery is closely related to the occurrence of cerebral vascular accidents. Stabilization of vulnerable plaque of carotid artery has significant influence on the prevention and treatment of cerebrovascular accidents. Animal experiments and clinical studies show that Chinese medicine has good stabilizing effect on vulnerable plaque of carotid artery. This article reviewed TCM etiology and pathogenesis, treatment prescriptions and mechanism of vulnerable plaque of carotid artery.

Objective: To review clinical characteristics of cardiac and pericardial hydatid cysts and assess the results of surgical treatment. Methods: From February 1978 to July 1999, 13 patients were diagnosed as heart and/or pericardium echinococcosis. There were nine male and four female. Their age ranged from 8 to 36 years ［mean (23.0±8.5) years］. 10 patients were symptomatic and 3 were asymptomatic. 3 patients had involvement of liver or lung. Pathologic cardiac murmur or cardiac enlargements were found in 10 patients. All patients were examined with chest roentgenograms, electrocardiogram and echocardiography. The serologic test was positive in 11 cases and negative in 3 cases. One right atrial cyst was removed under extracorporal circulation. 4 single pericardial cyst and multi-pericardial cyst were resected, 6 myocardial cysts and one complicated myocard ial and pericardial cysts were resected through puncture-aspiration endocystect omy. Results: All patients were followed up from six months to six years ［mean (3.5±1.5) years］. One late death occurred ten-month after operation, and the cause of death was heart failure. 3 patients had recurrence and were reoperated. Conclusion: The clinical characters may vary according to the number, size and location of cysts. Echocardiography is important for surgical planning. The results of endocystectomy of cardiac and pericardial echinococcosis were excellent.

Objective To evaluate the effect of propofol on lung cell apoptosis induced by acute pulmonary thromboembolism (APTE) .Methods Forty male SD rats weighing 280-300 g were randomly divided into 5 groups ( n = 8 each) : group Ⅰ sham operation ( group S) ; group ⅡAPTE and 3 propofol groups ( group P1-3). APTE was produced by iv injection of auto-blood clots. Venous blood 0.2 ml was obtained from rat tail vein and placed in a sterile test tube which was kept in water bath at 37 ℃ overnight. The blood clot was cut into thrombi ( diameter 1 mm, length 5 mm) the next day. Fifteen thrombi in 2 ml of normal saline were injected into immediately after iv injection of auto-bloed clots. The animals were killed at the end of 4 h propofol infusion and lung specimens were obtained for determination of lung cell apoptosis rate by flow eytometry and expression of caspase-3, Bax, Bcl-2, Fas, FasL mRNA and protein by RT-PCR and Western blot.The expression of Bcl-2/Bax mRNA and protein was calculated. Results Compared with group S,APTE significantly increased the lung cell apoptosis rate, and expression of caspase-3, Bax, Fas, FasL and decreased the expression of Bcl-2 and Bcl-2/Bax. Propofol infusion significantly attenuated these APTE-induced changes. Conclusion Propofol can inhibit APTE-induced lung cell apoptosis by down-regulating the caspase-3, Fas and FasL expression and regulating the balance between Bcl-2 and Bax expression.

Objective To analyze the clinical features of vasovagal syncope, enhance its clinial awareness and to promote the importance of history taking in the differential diagnosis of syncope. Methods A total of 83 patients with the diagnosis of vasovagal syncope were included in the study and their data were, undergone retrospective statistical analysis. Results A 63.9% of patients had recurrent syncope. There was 73.5% of them had motivation and 80.7% of them had presyncope symptoms. Complete loss of consciousness was found in 77.1% of patients. There was 39.1% of them had concomitant symptoms and 39.1% had postsyncopal symptoms. In 54.2% of the patients the duration of syncope was less than 2 minutes. Conclusion It is important to pay attention to history taking and to anylaze the clinical features in the diagnosis of vasovagal syncope.

Recently a number of acupuncture clinical trial projects mainly conducted by conventional scientists have generated many negative results. A large meta-analysis of patient-level acupuncture data for the treatment of chronic pain conditions have demonstrated that the effects of verum acupuncture on pain improvement have statistically significant, but small, differences compared with sham-acupuncture procedures and no difference between acupuncture points and non-points. These conclusions have puzzled the acupuncture community and made confusion for acupuncture research and practices. The purpose of this paper was to compare differences between acupuncture clinical practices and the trial studies, which include "acupuncture technical principles", "acupuncture clinical trial design", and "acupuncture practice based on the theory of traditional Chinese medicine". These factors contribute to the puzzle between the acupuncture community/practice and acupuncture clinical trials, which can be improved in future studies.
Acupuncture Points ; Acupuncture Therapy ; Chronic Disease ; Clinical Trials as Topic ; Humans ; Meta-Analysis as Topic ; Pain Management ; methods ; Research Design

Objective:To investigate the clinical and molecular genetic features of neonatal congenital Netherton syndrome (NS) caused by mutations in serine protease inhibitor of Kazal type 5 ( SPINK5) gene. Methods:This study retrospectively analyzed the clinical data of an NS neonate admitted to Shanghai Children's Hospital in November 2018. SPINK5 gene was analyzed using high-throughput sequencing and Sanger sequencing. Relevant articles were retrieved from various databases including China National Knowledge Infrastructure, Wanfang and PubMed, and the reported cases who were diagnosed as NS within two months after birth with SPINK5 gene sequencing results were reviewed. Clinical features, gene mutations, treatment and follow-up results of NS were summarized using descriptive statistical analysis. Results:The patient presented with diffuse erythema and desquamation, sparse hair and repeated infections shortly after birth. Laboratory tests revealed elevated IgE (111 IU/ml) and "invagination-like" change in the hair under optical microscope. SPINK5 gene analysis found that there were compound heterozygous mutations of c.2468dup (p.Lys824Glufs*4) and c.377_378del (p.Tys126*) in the child. The pedigree analysis found that the two mutations were respectively inherited from the father and the mother, which supported the diagnosis of NS caused by SPINK5 gene mutation. Though skin rash improved after comprehensive treatments including anti-infection therapy, gamma globulin injection and skincare, the patient suffered from recurrent infection and was discharged from the hospital after giving up treatment and died of infection at two months old. Eleven NS cases were retrieved from literature and altogether 12 cases were analyzed here. The most common clinical manifestations in the 12 patients were early skin diffuse erythema and desquamation (12/12), infection (8/12), dry hair (7/12), hypernatremia dehydration (7/12), high IgE (5/12), growth retardation (4/12), respiratory failure (3/12), atopic constitution (2/12), diarrhea (2/12), dysphagia (1/12), hypothermia (1/12), wheezing (1/12), hypertension (1/12), liver failure (1/12) and metabolic alkalosis (1/12). Conclusions:NS is caused by SPINK5 gene mutation with atypical manifestations in neonates. Neonates with diffuse erythema and desquamation of the skin, repeated infections, dry hair and especially with high blood IgE should be considered the possibility of NS. Genetic testing is conducive to early diagnosis, guiding treatment decisions and providing a basis for genetic counseling.

Objective To investigate the self-assembly and cellular localization patterns of fila-mentous temperature-sensitive protein Z (FtsZ) in Escherichia coli (E.coli) strains by using FtsZP74R, FtsZG77D and FtsZA81R mutants.Methods YFP or His labeled FtsZ proteins and the plasmids of FtsZ mu-tants were constructed by using molecular clone and site-directed mutagenesis methods.The targeted proteins were purified by affinity chromatography.FL37(△ftsZ-Cat) strains were constructed via linear DNA homol-ogous recombination.Living cell imaging was performed to observe the cellular localization patterns of FtsZ protein and its mutants in E.coli strains.The interactions between FtsZ-FtsZ/FtsZ mutants were examined by coi-mmunoprecipitation assay . The polymerization properties of FtsZ mutants were analyzed by light scattering.The activities of GTPase were monitored by using high performance liquid chromatography.Re-sults The P74, G77 and A81 amino acids were respectively replaced by different polar amino acids to change the amphipathicity of the helix within the domain of FtsZ ( 74-82 ) .The YFP-labeled FtsZP74R , FtsZG77D and FtsZA81R mutants failed to assemble into functional Z-ring structure in E.coli strains.The inter-actions between FtsZ protein and its mutants were weakened or completely disappeared.In addition, in vitro experiments showed that P74R, G77D and A81R mutations caused a decrease in the polymerization efficien-cy of FtsZ monomer.The activity of GTPase was significantly decreased in the FtsZA81R mutant. Conclusion The P74, G77 and A81 were critical amino acids in the function and assembly of FtsZ protein in E.coli strains.Moreover, A81 amino acid regulated the lateral interaction of FtsZ monomer and the activity of GTPase.

Objective To observe the effect of moxibustion on Sanyinjiao, Hegu acupoint first active phase of labor contractions pain.Methods One hundred and sixty cases of primipara were divided into test group by single blind, randomized methods (the Sanyinjiao acupoint group, Sanyinjiao acupoint and hegu point group) and control group(non-acupuncturev points group and the blank group).Each group with 40 cases.The patients were exerted mxibustion therapy 30 min in the Sanyinjiao acupoint group and Sanyinjiao acupoint and hegu point group, respectively in the maternal appear regularity uterine contraction pain, after ostium of uterus opened 3 cm.The women of the non-acupuncturev points group were exerted moxibustion therapy in the wrist horizontal stripes of radial side radial pulse place to elbow horizontal stripes biceps tendon of the midpoint of the radial side of attachment 30 min.The blank group women didn' t conduct notcarry moxibustion intervention.On the first active stage of labor time and uterine contraction pain were compared.Results The active labor time of Sanyinjiao group, Sanyinjiao and Hegu group,non acupoint group and blank control group patients were (116.11 ±65.89) min, (81.93 ± 53.45) min, (123.03 ± 7.67) min, (138.69 ± 104.01) min respectively, there was significant difference among Sanyinjiao and Hegu group, non acupoint group and blank group (P＜ 0.05), while the difference between the non acupoint group and blank group without statistical significance (P＞0.05).The first time of production process of 4 groups were (313.22± 141.15) min, (379.50± 182.82) min, (393.00 ±196.50) min, (488.08±236.61) min respectively, there was significant difference among Sanyinjiao group,Sanyinjiao and Hegu group and blank group differences (P ＜ 0.05).Moxibustion therapy after stopping, 2 h degree of cervical dilation of 4 groups were (8.37±2.19) cm, (8.14±2.74) cm, (7.64±2.91) cm, (6.29 ±3.05) cm respectively;contractions lasting time were (0.56±0.16) min, (0.52±0.13) min, (0.:48±0.17) min, (0.41± 0.09) min respectively;uterine contraction interval (2.98± 1.45) min, (2.56± 1.02) min, (3.89 ±1.54) min, (3.41 ± 1.32) min respectively;contraction strength enhaucement efficiency were 60.0％ (24/40) ,75.0％ (30/40), 17.5％ (7/40), 10.0％ (4/40) respectively, there were significant differences among Sanyinjiao group,Sanyinjiao and Hegu group,the non acupoint group and blank control group in terms of above indexes (P ＜ 0.05), while difference between the non acupoint group and blank group without statistical significance(P＞0.05).After the withdrawal of the moxibustion treatment 2 h, the pain reduction in childbirth of 4 groups were 52.5 ％ (21/40), 47.5％ (19/40), 22.5％ (9/40), 20％ (8/40) respectively, the pain reduction in childbirth of Sanyinjiao group, Sanyinjiao and Hegu Point Group were higher than that of non acupoint group and blank group, the differences were statistically significant (P＜0.05);while non acupoint group and blank group compared without statistically significant (P＞0.05).Conclusion The effect of Moxibustion at Sanyinjiao and Sanyinjiao compatibility Hegu Acupoint moxibustion on maternal production process and uterine contraction are significant, but combine with Acupoint Moxibustion can shorten the time of the active phase of labor, increase contraction of the uterus, promote the production process.

Objective To investigate the effect of postoperative TSH suppression on bone mineral density (BMD) in postmenopausal women with DTC.Methods Postmenopausal women with postoperative DTC underwent thyroid residual ablation or 131I treatment for metastases at Xin Hua Hospital between September 2009 and December 2014 were enrolled and followed for 2 years.They were divided into suppressive TSH group (median TSH＜0.30 mU/L;group 1) and non-suppressive group (median TSH≥0.30 mU/L;group 2).Lumber 1-4 BMD levels (T scores) were measured by a dual energy X-ray absorptiometry bone densitometer at baseline,1 year and 2 years after treatment.All patients had calcium and vitamin D supplementation after TSH suppression.The T scores were compared with Mann-Whitney u test and Kruskal-Wallis test.Results A total of 126 patients were enrolled and followed up for 2 years,including 65 with average age (57.65±6.65) years in group 1 and 61 with average age (56.19±7.17) years in group 2.The T scores in group 1 and group 2 at baseline were-1.70(-2.30,-0.55) and-1.30(-2.10,-0.30) (z=-1.660,P＞ 0.05).The difference of T scores was significant in group 1 at baseline,1-year follow-up and 2-year follow-up (-2.25(-2.48,-0.83),-1.95(-2.70,-0.60);H=6.244,P＜0.05),but not significantly different in group 2 (H=1.102,P＞0.05).The T values were different between the 2 groups both in 1-year follow-up and 2-year follow-up (z values:-2.170,-2.160,both P＜0.05).Conclusions TSH suppression significantly increases the risk of postoperative osteoporosis.The BMD should be followed up annually in postmenopausal DTC patients.

Objective: To explore safety and effects of exercise rehabilitation in aged patients with chronic heart failure (CHF). Methods: A total of 83 aged CHF patients were randomly divided into exercise rehabilitation group (n=42, received exercise training based on usual care) and usual care group (n=41, received usual care). Period of treatment was eight weeks and patients were followed up for 12 months. New York heart association (NYHA) classification was used to represent cardiac function. Left ventricular ejection fraction (LVEF), left ventricular end-diastolic dimension (LVEDd) were determined by ultrasound cardiography, 6 min walking distance (6MWD) and oxygen metabolic equivalent (METs) also were determined , plasma level of brain natriuretic peptide (BNP) was examined. Minnesota living with heart failure questionnaire (MLHFQ) was used to represent quality of life. Rehospitalization rate and mortality rate within 12 months were recorded in all patients. Results: On 8 th weeks after treatment, the LVEF, LVEDd and NYHA class of two groups all significantly improved（P＜0.05 all）,compared with usual care group, there were significant improvement in LVEF [（54.7±6.2）% vs. 65.4±8.7）%], LVEDd [（49.6±8.3）mm vs.（40.2±9.3）mm] and NYHA class [（2.7±0.8）classes vs.（1.9±0.9）classes], P<0.05 all; 6MWD [(122.7±9.2) m vs. (175.6±8.7) m] and METs [(5.8±1.8) vs. (8.4±2.4)] also significantly increased (P<0.01), and plasma level of BNP [(43.4±9.8) pg/ml vs. (31.7±8.9) pg/ml, P<0.05] significantly decreased in exercise rehabilitation group. No severe adverse events occurred in exercise rehabilitation group. After 12 months, compared with usual care group, there were significant increase in MLHFQ score [(45.6±8.2) scores vs. (68.9±7.9) scores], significant decrease in rehospitalization rate caused by heart failure (24.4% vs. 9.5%) , P<0.05 all in exercise rehabilitation group. Conclusion: Exercise rehabilitation is safe and effective in aged patients with chronic heart failure, which can significantly improve cardiac function, enhance exercise capacity and increase quality of life.